Provider First Line Business Practice Location Address:
4575 CAMINO DE LA PLZ STE 106
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN YSIDRO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92173-3157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-407-5555
Provider Business Practice Location Address Fax Number:
619-407-6718
Provider Enumeration Date:
12/21/2023